scholarly journals Congenital Diaphragmatic Hernia Presenting with Tension Pneumothorax in a 3-Year-Old Boy

2018 ◽  
Vol 06 (01) ◽  
pp. e63-e65 ◽  
Author(s):  
Maren Balks ◽  
Jan-Hendrik Gosemann ◽  
Ina Sorge ◽  
Martin Lacher ◽  
Franz Hirsch
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Bowel Perforation ◽  
Tension Pneumothorax ◽  
Upper Respiratory Tract ◽  
Thoracic Computed Tomography ◽  
Mediastinal Shift ◽  
Hollow Organ ◽  
Chest X Ray ◽  
The One

AbstractWe report the case of a 3-year-old boy who presented with an upper respiratory tract infection and severe dyspnea. A chest X-ray revealed a left-sided tension pneumothorax with mediastinal shift and suspected enterothorax. After thoracic computed tomography (CT) scan, a chest tube was inserted, which drained fluid which had the same consistency and color as the one derived from the nasogastric (NG) tube. The boy underwent diagnostic laparoscopy for suspected bowel perforation, which confirmed a left-sided Bochdalek hernia with herniation of the viscera into the chest. After repositioning of the herniated organs into the abdomen, a gastric perforation was identified and repaired. This case demonstrates that the cause of a tension pneumothorax in an infant may be a rare combination of congenital diaphragmatic hernia (CDH) and perforation of a visceral hollow organ.

Survival case of acute and severe respiratory distress due to spontaneous tension gastrothorax

2020 ◽  
Vol 13 (9) ◽  
pp. e235281
Author(s):  
Sanjan Asanaru Kunju ◽  
Prithvishree Ravindra ◽  
Ramya Kumar Madabushi Vijay ◽  
Priya Pattath Sankaran
Keyword(s):  
Tension Pneumothorax ◽  
Emergency Laparotomy ◽  
Severe Respiratory Distress ◽  
Mediastinal Shift ◽  
Breath Sounds ◽  
Chest X Ray ◽  
The Right ◽  
Tension Gastrothorax ◽  
Obstructive Shock ◽  
Survival Case

A 20-year-old woman presented with abdominal pain and shortness of breath. She was in obstructive shock with absent breath sounds on the left haemithorax. Chest X-ray showed a large radiolucent shadow with absent lung markings and mediastinal shift to the right side with concerns for tension pneumothorax. Though tube thoracostomy was done on the left side of the chest, column movement was absent. To confirm the diagnosis CT with contrast was done that revealed a huge left side diaphragmatic defect with abdominal contents in the thorax and mediastinal structures are shifted to left. She underwent emergency laparotomy and postoperative period was uneventful.

Late-Presenting Congenital Diaphragmatic Hernia: A Potentially Life Threatening Case

2009 ◽  
Vol 16 (2) ◽  
pp. 102-105 ◽  
Author(s):  
HY Chan ◽  
CC Wong ◽  
F Ng
Keyword(s):  
Respiratory Distress ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Clinical Symptoms ◽  
Late Onset ◽  
Sudden Onset ◽  
Mediastinal Shift ◽  
Wide Range ◽  
Urgent Operation ◽  
Life Threatening

Congenital diaphragmatic hernia (CDH) generally presents with respiratory distress in the neonatal period. Late onset CDH is less common and is associated with a wide range of clinical symptoms. We report a case of a 4-year-old child presenting with sudden onset of dizziness, abdominal pain and vomiting after swimming. Radiological investigations showed a left CDH with mediastinal shift. She gradually developed respiratory distress after admission. Urgent operation showed that the contents of the hernia included stomach, spleen, small and large bowels. This case highlights the importance of suspicion of CDH, proper clinical examination and investigation of children with acute non-specific gastrointestinal complaints.

scholarly journals Fetal MRI Mediastinal Shift Angle, Respiratory and Cardiovascular Pharmacological Support in Newborns With Congenital Diaphragmatic Hernia

2021 ◽  
Author(s):  
Ilaria Amodeo ◽  
Irene Borzani ◽  
Giulia Corsani ◽  
Nicola Pesenti ◽  
Genny Raffaeli ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Linear Models ◽  
Fetal Mri ◽  
Inverse Correlation ◽  
Lung Hypoplasia ◽  
Clinical Trial Registration ◽  
Mediastinal Shift ◽  
Shift Angle

Abstract Introduction. In newborns with congenital diaphragmatic hernia (CDH), the mediastinal shift caused by the herniated organs negatively affects lung development. Assessment of the fetal magnetic resonance imaging (MRI) mediastinal shift angle (MSA) was shown to have an inverse correlation with the total fetal lung volume (TFLV), being associated with neonatal survival. However, a possible association with postnatal morbidity has never been investigated. We hypothesize that the degree of the mediastinal shift could be associated with higher respiratory and cardiocirculatory impairment, requiring intensive treatments and extended hospitalization in survivors.Method. We retrospectively consider a cohort of isolated, left-sided CDH, for whom we calculated the MSA and the observed/expected (O/E) TFLV at fetal MRI. We performed a data collection regarding inotropic or vasoactive support, treatment with pulmonary vasodilators, mechanical ventilation, and length of stay. General linear models were performed. Results. The MSA and O/E TFLV were inversely correlated (Pearson’s coefficient -0.65, p < 0.001) and deceased patients showed higher MSA values then survivors (p = 0.011). Among survivors, an increase in MSA was associated with longer pharmacological treatments (dobutamine: p = 0.016; dopamine: p = 0.049; hydrocortisone: p = 0.003; nitric oxide: p = 0.002; sildenafil: p = 0.039; milrinone: p = 0.039; oxygen: p = 0.066), and mechanical ventilation (p = 0.005), with an increasing trend in the length of hospitalization (p = 0.089). Conclusions. The MSA indirectly reflects lung hypoplasia and is associated with the higher neonatal intensity of cares. Further studies are needed to consolidate the results. Clinical Trial Registration: The study is an exploratory post-hoc analysis of the registered NeoAPACHE protocol at ClinicalTrials.gov with the identifier NCT04396028

scholarly journals Neonatal Tension Pneumothorax.

2020 ◽  
pp. 1-2
Keyword(s):  
Bowel Perforation ◽  
Tension Pneumothorax ◽  
Male Infant ◽  
Clinical Image ◽  
Chest Drain ◽  
Chest Drainage ◽  
X Ray ◽  
Transient Improvement ◽  
Chest X Ray ◽  
Milk Feeding

Clinical Image A 690 g male infant delivered at 24+2 weeks had respiratory distress syndrome treated with Curosurf. Chest X-ray showed pulmonary interstitial emphysema (PIE) changes from day 5 onwards. On day 6 he suddenly developed desaturation with bradycardia, not responding to bagging. Auscultation revealed reduced air entry over right lung; endotracheal tube was changed for suspected blockage. Transient improvement noted. Then, the baby deteriorated again. Repeated auscultation showed markedly reduced air entry over right lung. Transillumination was positive. X-ray confirmed right tension pneumothorax but pneumoperitoneum was unexpected (Figure 1). The baby’s condition did not improve upon repeated chest tapping and required chest compression and Adrenaline. A chest drain was inserted and the baby then improved. Bowel perforation was once suspected but the infant improved so dramatically after chest drainage and milk feeding was subsequently established, ruling out bowel perforation.

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